Low frequency electrical stimulation through subdural electrodes in a case of refractory status epilepticus

Department of Neurology, David Geffen School of Medicine at UCLA, 710 Westwood Plaza, Room 1-194, Los Angeles, CA 90095, USA.
Clinical Neurophysiology (Impact Factor: 3.1). 05/2006; 117(4):781-8. DOI: 10.1016/j.clinph.2005.12.010
Source: PubMed


We delivered low frequency stimulation through subdural electrodes to suppress seizures in a case of refractory status epilepticus (RSE).
A 26-year-old female developed RSE after several days of febrile illness. Seizure control required continuous infusion of two anesthetics plus high doses of 2-4 enteral antiepileptic drugs. After 3 months of RSE, subdural strips were placed to determine surgical candidacy. Five independent ictal onset zones were identified. Because she was a poor candidate for epilepsy surgery and had a poor prognosis, the implanted subdural electrodes were used to administer 0.5 Hz stimulations to the ictal onset zones in 30 min trains daily for 7 consecutive days in an attempt to suppress seizures.
After 1 day of stimulation, one anesthetic agent was successfully discontinued. Seizures only returned by the 4th day when the second anesthetic had been reduced by 60%. Upon returning, seizures arose from only one of the 5 original ictal onset zones. Unfortunately, RSE persisted, and she eventually died.
In this case of RSE, low frequency stimulation through subdural electrodes transiently suppressed seizures from all but one ictal onset zone and allowed significant reduction in seizure medication.
Low frequency cortical stimulation may be useful in suppressing seizures.

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Available from: Noriko Salamon, Feb 25, 2015
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    • "High frequency stimulation (HFS) as a form of deep brain stimulation has been shown to inhibit pathologic neuronal activity through direct disruption of local network activities. In contrast low frequency stimulation (LFS) is thought to inhibit the activity by increasing the threshold for the firing of neuronal action potentials through more complex mechanisms (Albensi et al. 2004; Schrader et al. 2006). Moreover, LFS requires fewer pulses per second compared to other forms of DBS therapies, thereby lowering the required current injection and minimizing the potential for the stimulation-induced damage of the target tissue (Kile et al. 2010). "
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    ABSTRACT: In epilepsy, the anticonvulsant effects of low-frequency stimulation (LFS) are time dependent. We report the effects of 1.2g daily walnut (Juglans regia L) consumption after termination of kindling (Immediate LSF), and after cessation of after-discharges (Delayed LSF), on amygdaloid kindled seizures in male Wistar rats. Control and walnut consuming rats received daily kindling and low-frequency monophasic square-wave pulses of 1 Hz, 100 µA, 0.1 ms per pulse every 15 min. Results indicate an anti-convulsant effect of walnut pre-treatment in kindled induced seizures Walnut consumption and immediate LFS reduced electrical and behavioral parameters of kindling whereas delayed LFS had no significant effect. There was no significant interaction between the anticonvulsant effects of walnuts and LFS. Walnut consumption may have delayed the kindling procedure but did not interact with LFS effects.
    Full-text · Article · Jul 2013
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    • "In addition, previous experimental results using LFS have shown antiepileptic effects in clinical studies (Jerger & Schiff, 1995; Albensi et al., 2004; Morrell, 2011) and in animal studies (Velísek et al., 2002; Goodman et al., 2005; Schrader et al., 2006). However, the stimulation frequency and target capable of producing complete or near-complete suppression of seizure has not yet been found. "
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